Provider Demographics
NPI:1831220920
Name:AXTELL, PHILIP KENNETH (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:KENNETH
Last Name:AXTELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 SUTHERLAND AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2337
Mailing Address - Country:US
Mailing Address - Phone:865-556-6092
Mailing Address - Fax:865-895-4142
Practice Address - Street 1:2210 SUTHERLAND AVE STE 114
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2337
Practice Address - Country:US
Practice Address - Phone:865-556-8947
Practice Address - Fax:865-895-4142
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2763103TS0200X
TN2763103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent